心血管预防指南英文课件.pptx

1、Dr Chan, Ngai Yin, MBBS(HK), MRCP(UK), FRCP(Edin), FACC, FAHA,Associate Consultant,Director, Cardiac Pacing Services,Princess Margaret Hospital10th South China International Congress in Cardiology, Guangzhou, China, April 12, 2008CVD and other major causes of death: both sexes.(United States: 2004).

2、 Source: NCHS and NHLBI. Causes of Death-US57% of deaths due to CV diseasesIn 1998, the AHA Board of Directors adopted a 2010 Impact Goal:By 2010, to reduce coronary heart disease, stroke and risk by 25%.Risk factors to be measured included:Tobacco UsageHigh Blood PressureHigh CholesterolPhysical In

3、activityIn 2001, Obesity and Diabetes were added as risk factors.Our goal is to achieve a 0% growth rate in Obesity and Diabetes by 2010.22.8%18.8% Lifestyle modification Blood pressure control Lipid management Diabetes management Antithrombotic treatment Renin-Angiotensin-Aldosterone system blockad

4、e blockers Influenza vaccination Smoking-complete cessation, avoid environmental exposure Physical activity-30 minutes, 7 days per week (minimum 5 days per week) Weight management-BMI 18.5-24.9kg/m2, waist circumference 40 inches for men, 35 inches for women Patients with implantable devices Class I

5、 and II heart failure patients Patients with coronary artery disease after complete revascularization Patients with stable angina with satisfactory medical control Patients with valvular heart disease after surgical treatment Goal: 140/90mmHg or 130/80mmHg if patient has diabetes or chronic kidney d

6、isease Lifestyle modification As tolerated, add BP medication, treating initially with blockers and/or ACEI, with addition of other drugs such as thiazidesLaRosa JC, Grundy SM, Waters DD et al. Intensive lipid lowering with atorvastatinIn patients with stable coronary disease. NEJM 2005;352:1425-351

7、0001 pts with CHDAnd LDL130mg/dlMedian FU 4.9yearsMean LDL 77 vs 101LaRosa JC, Grundy SM, Waters DD et al. Intensive lipid lowering with atorvastatinIn patients with stable coronary disease. NEJM 2005;352:1425-35Primary endpoint:First major CV event, defined asDeath from CHD,Nonfatal MICardiac arres

8、t survivorFatal or nonfatal strokeLiver derangement:1.2% vs 0.2% (p0.001)Pedersen TR, Faergeman O, Kastelein JJ et al. High-dose atorvastatin vs usual-dose Simvastatin for secondary prevention after myocardial infarction. JAMA 2005;294:2437-454439 (high dose) vs 4449 ptsWith history of MIPrimary end

9、point:Major coronary event defined asCoronary death, nonfatal AMI, orCardiac arrest survivorNo difference in CV or All-cause mortality80mg Atorvastatin20mg SimvastatinPedersen TR, Faergeman O, Kastelein JJ et al. High-dose atorvastatin vs usual-dose Simvastatin for secondary prevention after myocard

10、ial infarction. JAMA 2005;294:2437-45Shephard J, Kastelein JJP, Bittner V et al. Intensive lipid lowering with atrovastatin in patientsWith coronary heart disease and chronic kidney disease. JACC 2008;51:1448-5410001 pts with CHD9656 with renal data3107 CKD (GFR60ml/min/1.73m2vs 6549 normal GFR Diet

11、 therapy LDL-C 100mg/dL, further reduction of LDL-C to 70mg/dL is reasonable If TG 200-499mg/dL, non-HDL-C should be 130mg/dL If TG 500mg/dL, prevent pancreatitis with fibrate or niacin before LDL lowering Lipid-lowering medications: statin, fibrate, niacin, bile acid sequestrants, ezetimibe Lifesty

12、le modification and pharmacotherapy Goal: HbA1c7% Lifelong aspirin 75-162mg/d Aspirin 100-325mg/d within 48h of SVG, higher dose for 1 year Aspirin 325mg/d postPCI (1 month BMS, 3 months SES, 6 months PES) +Clopidogrel 75mg/d up to 12 months for ACS, postPCI (1 month BMS, 3 months SES, 6 months PES)

13、 Warfarin with INR 2-3 for PAF, CAF or flutterBraunwald E, Domanski MJ, Fowler SE et al. Angiotensin-converting enzymeInhibition in stable coronary artery disease. NEJM 2004;351:2058-69P=0.438290 pts randomized4mg trandolapril or placeboPrimary endpoint:Death from CV causes, MI,Or coronary revascula

14、rization ACEI-LVEF40%, HT, DM, or CKD-Low-risk, normal LVEF, optional ARB-ACEI intolerant-Combination with ACEI in systolic heart failure Aldosterone blockade-post-MI patients, on ACEI and blocker, either DM or heart failure, LVEF40% MI, ACS, or LVD with or without heart failure symptoms (I, A) All other patients with coronary or other vascular disease or diabetes (IIa, C)Framingham Heart Study2489 men and 2856 women30-74 yo12 years FU383 men and 227 womenDeveloped CHD12 European cohort205178 subjects18 years FU7934 CV deathsMortality ratePer 100,000?